Introduction
It is crucial that all health care professionals who care for pregnant women recognise all of them that need a caesarean section.
There are women that absolutely need a caesarean section, and who should be encouraged to have an elective (planned) procedure. Such procedures are usually done in the day time by senior surgeons with all support staff present and everything needed for a successful procedure. They are generally safer than emergency surgeries. In emergencies, the patient can come with a full stomach, which can constitute an anaesthetic hazard. Vomiting and aspiration of the vomitus can lead to death especially when anaesthesia has knocked off the reflexes
In such situations, light anaesthesia in which the reflexes are intact is safer than deep general anaesthesia. When the reflexes are intact, the woman is unlikely to aspirate her vomitus salivary secretions, blood, concoctions, dentures or anything in the mouth
Spinal and/or epidural anaesthesia can also be used if an anaesthetist is available. In emergencies, the woman can come anaemic and/or infected, and blood or potent parenteral antibiotics may not be immediately available. Every comprehensive emergency obstetric care facility should offer blood transfusion services readily and should have potent parenteral antibiotics and oxygen at all times. Senior surgeons should also be available 24 hours of the day. Otherwise, lives can be lost in emergencies.
Surgeons must insist that those that need caesarean section should have it electively and not appear in the hospital as emergency patients.
Labour should be monitored closely to detect those whose labour failed to progress satisfactorily so as to offer them caesarean section on time to avoid a more complicated operation occasioned by delay. Such patients may have relative indications for a caesarean section like cord accidents, persistent malposition of a baby or severe hypertension in pregnancy, undiagnosed fibroid in the lower uterine segment or placenta
It is important that obstetricians or midwives monitoring women with a scar in their wombs who are in labour or women whose wombs are weak should quickly offer them caesarean section if the progress of labour is less than optimal to avoid uterine rupture. Early recourse to caesarean section is preferable to augmentation or induction of labour. Stimulation of the uterus in the face of obstruction can result in a disaster-uterine rupture.
Every pregnant woman that needs caesarean section should be known, and caesarean section should be quickly done expeditiously by trained surgeons who also should have what they need to do a good job.
